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The sequential organ failure assessment ( SOFA ) score is an effective triage marker following staggered paracetamol (acetaminophen) overdose
Author(s) -
Craig D. G.,
Zafar S.,
Reid T. W. D. J.,
Martin K. G.,
Davidson J. S.,
Hayes P. C.,
Simpson K. J.
Publication year - 2012
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2012.05102.x
Subject(s) - medicine , sofa score , acetaminophen , triage , receiver operating characteristic , liver transplantation , encephalopathy , renal replacement therapy , anesthesia , transplantation , sepsis , emergency medicine
Summary Background The sequential organ failure assessment ( SOFA ) score is an effective triage marker following single time point paracetamol (acetaminophen) overdose, but has not been evaluated following staggered (multiple supratherapeutic doses over >8 h, resulting in cumulative dose of >4 g/day) overdoses. Aim To evaluate the prognostic accuracy of the SOFA score following staggered paracetamol overdose. Methods Time‐course analysis of 50 staggered paracetamol overdoses admitted to a tertiary liver centre. Individual timed laboratory samples were correlated with corresponding clinical parameters and the daily SOFA scores were calculated. Results A total of 39/50 (78%) patients developed hepatic encephalopathy. The area under the SOFA receiver operator characteristic for death/liver transplantation was 87.4 (95% CI 73.2–95.7), 94.3 (95% CI 82.5–99.1), and 98.4 (95% CI 84.3–100.0) at 0, 24 and 48 h, respectively, postadmission. A SOFA score of <6 at tertiary care admission predicted survival with a sensitivity of 100.0% (95% CI 76.8–100.0) and specificity of 58.3% (95% CI 40.8–74.5), compared with 85.7% (95% CI 60.6–97.4) and 75.0% (95% CI 65.2–79.5) , respectively, for the modified Kings College criteria. Only 2/21 patients with an admission SOFA score <6 required renal replacement therapy or intracerebral pressure monitoring. SOFA significantly outperformed the Model for End‐stage Liver Disease, but not APACHE II , at 0, 24‐and 48‐h following admission. Conclusions A SOFA score <6 at tertiary care admission following a staggered paracetamol overdose,is associated with a good prognosis. Both the SOFA and APACHE II scores could improve triage of high‐risk staggered paracetamol overdose patients.